Three Steps That Improve Star Ratings: A Focus on Medication Adherence

Medication adherence is one of the most challenging, yet most impactful ways to improve Star Ratings. But why is medication adherence so challenging? Traditional programs typically focus on closing individual gaps in a measure, but only scratch the surface when it comes to uncovering the root cause of non-adherence. The challenge also lies within the behavior of each member. Behaviors, beliefs and attitudes are extremely personal. To change these, you must move beyond treating members as data points, instead focusing on holistic care that supports the needs of each individual.

Following are three crucial steps to improve the triple-weighted Stars Medication Adherence measures:

Step 1: Address the Gaps and Challenges of Your Current Medication Adherence Program

Prior to making any changes to your medication adherence program, it is important to reflect on your current program to see where any critical gaps may lie. Common gaps seen in today’s programs are:

  • Members are typically identified when they are already non-adherent, which may be too late to change behaviors
  • The root cause of non-adherence isn’t addressed—even if you get the member to be adherent today, he or she may not stay that way for long
  • Not understanding what a vendor may be doing for outreach and whether they’re optimizing their efforts for future success
  • Starting outreach efforts too late in the year and not planning for future measurement years

Step 2: Build the Foundation for a Successful Medication Adherence Program

To improve the return on investment (ROI) of your medication adherence program, it is important to prioritize those members who are likely to change their behavior. There is no point in using resources to contact someone who may never answer the phone or be receptive to the program being offered. Using unique data points and not solely relying on medical and pharmacy claims can best illustrate who the ideal member for outreach may be.

Predictive models, machine-learning and artificial intelligence (AI) also help to identify members before it is too late. As mentioned, typical medication adherence programs find members long after becoming non-adherent, with many identified as non-adherent after a major health event, such as a heart attack or hospitalization. With analytic tools in place, members can be found at earlier intervention points along their journeys—some even before they’ve become non-adherent.

Step 3: Uncover Member Barriers to Medication Adherence

Improving program ROI also requires a focus on long-term results. By addressing the root cause of non-adherence versus simply focusing on closing individual gaps in quality, you can make a significant impact on adherence results for years to come—not just in a single reporting year. Medication adherence barriers are not simply data points, but pieces of information about complex individuals that must be uncovered and addressed appropriately. Each member must be carefully interviewed and coached on what affects and motivates them when it comes to finding their path to adherence.

A Targeted and Personalized Approach to Medication Adherence

Health Dialog uses a targeted and personalized approach to medication adherence that addresses these issues. We identify members at-risk for medication non-adherence—often before they actually become non-adherent—by utilizing the Pathways Engine, our predictive analytics and machine learning platform. Our Pathways Engine utilizes over 600 data points, incorporating medical and prescription claims history and socio-economic factors, as well as other clinical identifiers and care gaps, to ensure we select the most appropriate members to target. We then utilize sophisticated mapping techniques to determine which members are most receptive to interventions, the interventions they are most likely to respond to and their preferred communication channel for maximum impact. Our specially trained Care Navigators then engage the member to determine the root cause of their non-adherence, establishing a solid foundation of on-going medication-taking behavior and empowering members to overcome barriers to adherence.

By focusing on these three steps, health plans can build a solid foundation for a medication adherence program that will endure as Star measure cut points continue to increase.

Topics: Trends & Insights, Medication Adherence

Receive Insights in your Inbox


Health Dialog can help you address these three concerns. Download our infographic.
AIM Infographic Image